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escendants of lepers； or to have been the victims of leprosy themselves。 From the descriptions there is a decided difference between the Cagots and the cretins。 In a recent issue of Cosmos a writer describes Cagots as follows：
〃They inhabit the valley of the Ribas in the northwestern part of the Spanish province now called Gerona。 They never exceed 51 1/2 inches in height； and have short； ill…formed legs； great bellies； small eyes； flat noses； and pale； unwholesome complexions。 They are usually stupid； often to the verge of idiocy； and much subject to goiter and scrofulous affections。 The chief town of the Ribas Valley is Ribas； a place of 1500 inhabitants。 about 800 feet above sea…level。 The mountains rise about the town to a height of from 6000 to 8000 feet； and command an amazingly beautiful panorama of mountain； plain； and river； with Spanish cities visible upon the one side and French upon the other。 The region is rich； both agriculturally and minerally； and is famous for its medicinal springs。 In this paradise dwell the dwarfs； perhaps as degraded a race of men and women as may be found in any civilized community。 They are almost without education； and inhabit wretched huts when they have any shelter。 The most intelligent are employed as shepherds； and in summer they live for months at an elevation of more than 6000 feet without shelter。 Here they see no human creature save some of their own kind； often idiots； who are sent up every fifteen or twenty days with a supply of food。
〃It is said that formal marriage is almost unknown among them。 The women in some instances are employed in the village of Ribas as nurses for children； and as such are found tender and faithful。 Before communication throughout the region was as easy as it is now； it was thought lucky to have one of these dwarfs in a family； and the dwarfs were hired out and even sold to be used in beggary in neighboring cities。 There are somewhat similar dwarfs in other valleys of the Pyrenees； but the number is decreasing； and those of the Ribas Valley are reduced to a few individuals。〃
Hiccough is a symptom due to intermittent； sudden contraction of the diaphragm。 Obstinate cases are most peculiar； and sometimes exhaust the physician's skill。 Symes divides these cases into four groups：
（1） Inflammatory； seen particularly in inflammatory diseases of the viscera or abdominal membranes； and in severe cases of typhoid fever。
（2） Irritative； as in direct stimulus of the diaphragm in swallowing some very hot substance； local disease of the esophagus near the diaphragm； and in many conditions of gastric and intestinal disorder； more particularly those associated with flatus。
（3） Specific or idiopathic； in which there are no evident causes present； it is sometimes seen in cases of nephritis and diabetes。
（4） Neurotic； in which the primary cause is in the nervous system；hysteria； epilepsy； shock； or cerebral tumors。
The obstinacy of continued hiccough has long been discussed。 Osler calls to mind that in Plato's 〃Symposium〃 the physician； Eryximachus； recommended to Aristophanes； who had hiccough from eating too much； either to hold his breath or to gargle with a little water； but if it still continued； 〃tickle your nose with something and sneeze； and if you sneeze once or twice even the most violent hiccough is sure to go。〃 The attack must have been a severe one； as it is stated subsequently that the hiccough did not disappear until Aristophanes had excited the sneezing。
Among the older medical writers Weber speaks of singultus lasting for five days； Tulpius； for twelve days； Eller and Schenck； for three months； Taranget； for eight months； and Bartholinus； for four years。
At the present day it is not uncommon to read in the newspapers accounts of prolonged hiccoughing。 These cases are not mythical； and are paralleled by a number of instances in reliable medical literature。 The cause is not always discernible； and cases sometimes resist all treatment。
Holston reports a case of chronic singultus of seven years' standing。 It had followed an attack of whooping…cough； and was finally cured apparently by the administration of strychnin。 Cowan speaks of a shoemaker of twenty…two who experienced an attack of constant singultus for a week； and then intermittent attacks for six years。 Cowan also mentions instances of prolonged hiccough related by Heberden； Good； Hoffman； and Wartmouth。 Barrett is accredited with reporting a case of persistent hiccough in a man of thirty…five。 Rowland speaks of a man of thirty…five who hiccoughed for twelve years。 The paroxysms were almost constant； and occurred once or twice a minute during the hours when the man was not sleeping。 There was no noise with the cough。 There is another case related in the same journal of a man who died on the fourth day of an attack of singultus； probably due to abscess of the diaphragm； which no remedy would relieve。 Moore records a case of a child； injured when young； who hiccoughed until about twenty years of age （the age at the time of report）。 Foot mentions a lad of fifteen who； except when asleep； hiccoughed incessantly for twenty…two weeks； and who suffered two similar； but less severe； attacks in the summer of 1879； and again in 1880。 The disease was supposed to be due to the habit of pressing the chest against the desk when at school。 Dexter reports a case of long…continued singultus in an Irish girl of eighteen； ascribed to habitual masturbation。 There was no intermission in the paroxysm； which increased in force until general convulsions ensued。 The patient said that the paroxysm could be stopped by firm pressure on the upper part of the external genital organs。 Dexter applied firm pressure on her clitoris； and the convulsions subsided； and the patient fell asleep。 They could be excited by firm pressure on the lower vertebrae。 Corson speaks of a man of fifty…seven who； after exposure to cold； suffered exhausting hiccough for nine days； and also records the case of an Irish servant who suffered hiccough for four months； the cause was ascribed to fright。 Stevenson cites a fatal instance of hiccough in a stone…mason of forty…four who suffered continuously from May 14th to May 28th。 The only remedy that seemed to have any effect in this case was castor…oil in strong purgative doses。
Willard speaks of a man of thirty…four who began to hiccough after an attack of pneumonia； and continued for eighty…six hours。 The treatment consisted of the application of belladonna and cantharides plasters； bismuth； and lime…water； camphor； and salts of white hellebore inhaled through the nose in finest powder。 Two other cases are mentioned by the same author。 Gapper describes the case of a young man who was seized with loud and distressing hiccough that never ceased for a minute during eighty hours。 Two ounces of laudanum were administered in the three days without any decided effect； producing only slight languor。
Ranney reports the case of an unmarried woman of forty…four who suffered from paroxysms of hiccough that persisted for four years。 A peculiarity of this attack was that it invariably followed movements of the upper extremities。 Tenderness and hyperesthesia over the spinous processes